Provider Demographics
NPI:1750390191
Name:VIRELLA, ANTHONY A (MD PROFESSIONAL CORP)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:A
Last Name:VIRELLA
Suffix:
Gender:M
Credentials:MD PROFESSIONAL CORP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6788
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91359
Mailing Address - Country:US
Mailing Address - Phone:805-449-0088
Mailing Address - Fax:805-449-0046
Practice Address - Street 1:30300 AGOURA ROAD
Practice Address - Street 2:SUITE 170
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301
Practice Address - Country:US
Practice Address - Phone:805-449-0088
Practice Address - Fax:805-449-0046
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72225207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA72225Medicare PIN